Provider Demographics
NPI:1609963230
Name:ZWEMER, JACK EVERETT (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:EVERETT
Last Name:ZWEMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:465 SAINT MICHAELS DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7670
Mailing Address - Country:US
Mailing Address - Phone:505-986-8620
Mailing Address - Fax:505-820-2461
Practice Address - Street 1:455 SAINT MICHAELS DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7601
Practice Address - Country:US
Practice Address - Phone:505-986-8620
Practice Address - Fax:505-820-2461
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM84-293207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00035063Medicaid
NM00NM003087OtherBLUE CROSS&BLUE SHIELD
E88075Medicare UPIN